Healthcare Provider Details

I. General information

NPI: 1568009090
Provider Name (Legal Business Name): AMELIA KIPKORIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 KRISTEN CT
RIVERSIDE CA
92501-1781
US

IV. Provider business mailing address

4437 KRISTEN CT
RIVERSIDE CA
92501-1781
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-0347
  • Fax:
Mailing address:
  • Phone: 951-224-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95381659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: